血天冬氨酸氨基转移酶与血小板比值在极低/超低出生体重儿肠外营养相关胆汁淤积中的诊断价值  

Diagnostic value of aspartate aminotransferase-to-platelet ratio index in parenteral nutrition associated cholestasis of very low/extremely low birth weight infants

作　　者：李艳红[1] 邱红[1] 门光国[1] 毛壬萍 王晓珺[1] 吕勤[1] LI Yanhong;QIU Hong;MEN Guangguo;MAO Renping;WANG Xiaojun;LYU Qin(Neonatal Intensive Care Unit,Ningbo Women and Children's Hospital,Ningbo 315012,China)

机构地区：[1]宁波市妇女儿童医院NICU,315012

出　　处：《浙江医学》2021年第13期1415-1419,共5页Zhejiang Medical Journal

基　　金：浙江省卫生健康科技计划项目(2021KY1049)。

摘　　要：目的探讨血天冬氨酸氨基转移酶与血小板比值(APRI)在极低/超低出生体重儿(VLBWI/ELBWI)肠外营养(PN)相关性胆汁淤积(PNAC)中的早期诊断价值。方法收集2018年1月至2019年12月在宁波市妇女儿童医院NICU住院的PN支持治疗超过14 d的VLBWI/ELBWI 147例的临床资料,按照住院期间患儿有无发生PNAC,分为PNAC组56例和非PNAC组91例。比较两组患儿营养支持情况、住院治疗情况、住院期间并发症发生情况及出生后不同时间患儿血生化指标和APRI。结果PNAC组患儿PN使用时间、达足量肠内喂养时间、脂肪乳剂使用时间、住院时间均长于非PNAC组,住院期间败血症和新生儿坏死性小肠结肠炎发生率均高于非PNAC组,差异均有统计学意义(均P<0.05)。PNAC组患儿出生后60 d或出院前ALT高于非PNAC组,生后30、60 d或出院前AST、TBil、DBil、TBA均高于非PNAC组,生后14、30、60 d或出院前APRI均高于非PNAC组,差异均有统计学意义(均P<0.05)。结论VLBWI/ELBWI发生PNAC时APRI在出生后14 d即有明显升高,APRI可作为VLBWI/ELBWI发生PNAC的早期预测指标。Objective To analyze the diagnostic value of aspartate aminotransferase-to-platelet ratio index(APRI)in parenteral nutrition associated cholestasis(PNAC)of very low/extremely low birth weight infants(VLBWI/ELBWI).Methods One hundred and forty-seven VLBWI/ELBWI who received parenteral nutrition more than 14 days in NICU of Ningbo Women and Children's Hospital from January 2018 to December 2019 were included in the study.During the hospitalization PNAC occurred in 56 cases(PNAC group)and did not occur 91 cases(non-PNAC group).The nutritional support,treatment and complication,biochemical indexes and APRI values between the two groups were compared at different time points.Results The parenteral nutrition use time,reaching enteral feeding time,the fat emulsion use time and hospitalization time in PNAC group were all longer than those in non-PNAC group(all P<0.05).The incidences of complications with neonatal necrotizing enterocolitis and sepsis in PNAC group were both higher than that in non-PNAC group(both P<0.05).ALT at postnatal 60 days or before discharge in PNAC group was higher than that in non-PNAC group(P<0.05).AST,TBil,DBil,TBA at postnatal 30,60 days or before discharge in PNAC group were higher than those in non-PNAC group(all P<0.05).The APRI values at postnatal 14,30,60 days or before discharge in PNAC group were higher than those in non-PNAC group(all P<0.05).Conclusion The APRI value is increased significantly at postnatal 14 days when PNAC occured in VLBWI/ELBWI,suggesting it may be used as an indicator for early diagnosis of PNAC.

关 键 词：极低/超低出生体重儿 胆汁淤积 血天冬氨酸氨基转移酶与血小板比值 肠外营养 

分 类 号：R722.6[医药卫生—儿科]